—Proper active measures usually prove promptly effective. The nail should be removed with forceps. Pain may be prevented by first injecting a 4-per-cent. solution of cocaine under the nail. The parts are then dressed with iodoform. A day or two later, after brushing the parts with a 4-per-cent. solution of cocaine, the ulcerating area is touched with nitrate of silver or with the tincture of the chloride of iron. This should be repeated, if need be, sev eral times at two or three days' interval. If this prove insufficient, acid nitrate of mercury must be used after anresthe tizing the parts with a 10-per-cent. solu tion of cocaine. Such an application may also be rendered painless, according to Randolph, by saturating the nitric acid with the hydrochlorate of cocaine.
Hypertrophy.
Hypertrophy of the nails is usually ascribed to pressure. It may affect the hands, but is met with, in the majority of cases, in the nails of the feet. The thickening may affect any part of the nail regularly or irregularly, a broad raised mass being sometimes the only evidence of the abnormal process. In the majority of cases, however, the hy pertrophy is irregular, the epithelial growth being restricted to areas. The nail, under these circumstances, becomes covered or bosselated and simultaneously yellowish gray, opaque, and very brittle. Though the growth is very gradual, pressure upon the underlying tissues causes local disorders, especially if the nail cracks, when painful inflammatory symptoms follow. It produces heat and discomfort when affecting the feet, shoes being worn with difficulty. When the nails of the hands are the seat of the hypertrophy it constitutes quite a de formity.
TREATMENT.—The overgrowth should be filed down or sawed. In other words, measures tending to give the nail its nor mal shape should be resorted to. All complications are of the nature of those attending the so-called "ingrowing toe nail" and the treatment given for the latter condition is also applicable.
Ingrowing Toe-nail.
The term "ingrowing toe-nair is ap plied to a condition usually confined to the great toe, in which the edge of the nail (almost always the outer edge) is forced into the adjoining soft parts. Swelling of the latter being induced, they overlap the nail, the point of con tact becoming the seat of ulceration and granulations. It is usually due to the pressure of tight shoes, and is therefore generally met with in young adults. It
is also frequently encountered in soldiers r, 1117- of prolon,2,id marching with au\ .o.« utienients that increase the r,s,mt p ti the fuet. Lymphatic sub ari more liable to it than others, an 1 th - off, et ion ,s exceedingly persistent f.11.1-1 It often accompanies diabetes ' mav et cur azz. a complication of "P•r tbstasLs of long duration, fract ,.r.. ark] other processes tending to de + i.tate the org„anism. hyperidrosis, etc., Jt ti.o-t frequently as a result of badly ;1.ared shoe=.
11.111.0, jag toe-nails in au infant 1 tt,t Is lly the end of the third week tl e e.unlition became such that operation as undertaken. T. W. Parry (Lancet, ()it. 14. 'W..
-In mild cases properly fitting shoes giving freedom to the toes, trtquent ablutions, and finely-powdered I rax or tannin applied to the dressed usually suffice for a cure. The 1.7Lre daily introduction of cotton under tl,e edze of the nail by gradually raising ti,c latter away from the soft parts is sr metimes very satisfactory. Scraping tbe centre of the nail until it is quite thin occasionally suffices to relieve the 1- assure.
In the great majority of cases the • -tration requires active measures he s: I. s a change of foot-wear. The -ulcer -t-ed ti-,ues must first be relieved of their 2rannlati( ns. This can easily be done by tv--ing the Cneture of the chloride of iron ai,er anmsthetizing the parts with a -I I .r-ccnt. solution of cocaine. Or they n. y be scraped with a curette or gently ,-Auterizid with the mitigated stick: ox.de of zinc and nitrate of silver. This I cing done, a small piece of cotton-wool covered with iodoform, iodol, or aristol is g.ently inserted with a probe into the (Li:eased cavity, the soft parts being raised from the nail. These measures do not always. procure a radical cure, how ever, particularly if the patients again use narrow or short-tipped shoes. In each case surgical measures are preferable.
The simplest of these is to anmsthetize the tissues—or the patient—and, after careful cleansing of the parts, to simply pare off the redundant tissues, granula tions and all, on a level with the edge of the nail. The nail-edge being then care fully trimmed. an iodoform dressing is applied. Or the dressed parts may be dissected out and a plastic union ob tained by a few stitches.